Case Report of Multidisciplinary Management of Peripartum Cardiomyopathy

Abstract

Peripartum cardiomyopathy (PPCM) is a form of heart failure that occurs during pregnancy or in the postpartum period, characterized by reduced left ventricular systolic function [1]. Peripartum cardiomyopathy is one of the leading causes of maternal mortality and morbidity worldwide.

Aim. To demonstrate, through a clinical case, the importance of early diagnosis, timely risk factor identification, and optimized strategies for treatment, delivery, and postpartum care.

Case Report. Patient B, a 36-year-old woman, was urgently admitted to the hospital on the sixth day postpartum due to progressive symptoms of acute heart failure. Examination confirmed peripartum cardiomyopathy, acute heart failure (Killip III, pulmonary edema), severe mitral regurgitation, left atrial dilation, moderate tricuspid regurgitation, moderate pulmonary hypertension, and massive bilateral pleural effusion. The left ventricular ejection fraction (LVEF) was 36 %, with NYHA Functional Class IV. Bilateral thoracentesis was performed, and acute heart failure therapy was administered in the intensive care unit for five days, leading to clinical improvement and improved laboratory and instrumental findings. The patient received heart failure therapy, including bromocriptine, and was managed by a multidisciplinary team of cardiologists, obstetricians, cardiac surgeons, and intensivists. At discharge, the patient’s condition was stable. Echocardiography revealed reduced mitral regurgitation (from severe to moderate), decreased left atrial size, and an LVEF increase to 40 %. NT-proBNP was 533.2 pg/mL, with other laboratory parameters within normal limits. Long-term outcomes were assessed at 2, 6, and 14 months post-discharge. At 14-month follow-up, complete recovery of myocardial and mitral valve function was observed, with a stable clinical condition.

Conclusions. Peripartum cardiomyopathy remains a serious cause of maternal and perinatal morbidity and mortality. Timely diagnosis and management of this condition are possible only through close collaboration within a multidisciplinary team comprising obstetrician-gynecologists, cardiologists, cardiac surgeons, and anesthesiologist-intensivists. Coordinated actions of these specialists contribute to optimizing the management of pregnancy, delivery, and the postpartum period, as well as improving long-term outcomes for both mother and child.